Provider Demographics
NPI:1750375861
Name:MANDZY, SVITLANA J (MD)
Entity type:Individual
Prefix:DR
First Name:SVITLANA
Middle Name:J
Last Name:MANDZY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-489-5750
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-893-7462
Practice Address - Fax:502-212-7551
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36466207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6109684127217OtherANTHEM SR. ADVANTAGE
KY1155612Medicaid
KY000000197267OtherANTHEM BC/BS
KY1750375861OtherRAILROAD MEDICARE
KY64046345Medicaid
KY1750375861Medicare PIN
KY000000197267OtherANTHEM BC/BS